Your Informed Consent

Consent Form (Adults)

Before completing this form, please read this short page about my standards and commitments to you, available here. If you happy with them, please complete this form and click ‘submit’ at the bottom of the page. You will receive a copy automatically and I will save a copy securely and confidentially. Please let me know if you have any questions or queries about the Consent Form by emailing: or Mobile/text: 07732 673 197.
Contact Details
How and in what circumstances would you like to be contacted
12. Urgent and Emergency Contact Details *** (for use in a rare and unexpected situation only) ***